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Goldsmith S R - - 1993
PURPOSE: To compare and contrast the pathophysiology and therapy of heart failure with normal and abnormal systolic ventricular function. METHODS: Review of basic pathophysiologic mechanisms, clinical data, and therapeutic trials. CONCLUSIONS: The clinical features of heart failure may be similar regardless of whether ventricular function is normal or abnormal. However, ...
Pohl U - - 1993
An abnormality of myocardial cell function is the primary pathophysiologic basis of heart failure. However, complex alterations of the whole circulatory system are also pathophysiologically important. At an early stage these alterations represent adaptive mechanisms which compensate for the impaired cardiac output. Later on, however, they induce a vicious circle ...
Cuny J - - 1993
Chronic heart failure (CHF) is a clinical syndrome characterized by left ventricular dysfunction secondary to the loss of functional cardiac contractile cells following some type of myocardial damage. In response to this cell loss, several hemodynamic and neurohormonal compensatory mechanisms are activated, which can become deleterious over time. Direct-acting vasodilators, ...
Cross J A - - 1993
The use of positive inotropic agents in the acute and chronic treatment of heart failure is associated with a variety of hemodynamic effects. The beneficial effects of these agents, however, are not without associated adverse effects. An increase in cardiac output is achieved through diverse pharmacologic mechanisms of action depending ...
Remme W J - - 1993
Although prevention of heart failure recently has become a realistic issue, management of heart failure once the syndrome has developed, is mainly supportive, based on the various cardiac and peripheral changes which occur in the course of heart failure. Of these, abnormal neurohormonal activation is of major pathophysiologic and prognostic ...
van Veldhuisen D J - - 1993
OBJECTIVES: This study was conducted to determine the efficacy and safety of long-term treatment with the orally active dopamine agonist ibopamine in patients with mild to moderate chronic congestive heart failure and to compare the results with those of treatment with digoxin and placebo. BACKGROUND: Ibopamine and digoxin are drugs ...
Pinto Y M - - 1993
OBJECTIVE: The cardiac renin-angiotensin system is activated in experimental heart failure, but it is unknown at what stage of heart failure it becomes activated, and whether activation is related to ventricular dysfunction and dilatation. Changes in activity of cardiac, renal, and plasma angiotensin converting enzyme (ACE) were therefore examined at ...
Re R N - - 1993
The renin-angiotensin system has long been known as a potent determinant of cardiovascular homeostasis and a powerful regulator of vascular hemodynamics. Over the last twenty years, it has become clear that components of the renin-angiotensin system are present in and, in many instances, synthesized in local tissues. The role of ...
Spencer C - - 1993
Ibopamine is an orally administered dopamine agonist which is rapidly converted to its active metabolite epinine by esterase hydrolysis. Ibopamine acts predominantly as a vasodilator and inhibitor of neuroendocrine activation in congestive heart failure, but also has mild positive inotropic effects at higher doses. The beneficial effects on cardiac and ...
Khosla S - - 1993
Management of congestive heart failure in the past has focused on sodium and fluid restriction, rest, and digitalis glycosides. Now, significant new evidence justifies early and aggressive ACE inhibitor therapy in patients with asymptomatic or mildly symptomatic LV dysfunction. ACE inhibitors reduce the likelihood of symptomatic heart failure in asymptomatic ...
Pagel P S - - 1993
Several important questions remain to be answered by future research. First, it is unclear whether any abnormal index of diastolic function can be used to estimate disease severity, or to prognostically identify patients who will subsequently develop systolic abnormalities or frank left ventricular dysfunction. A temporal relationship between the appearance ...
Fara A M - - 1993
Ventricular remodeling is a pathologic change in the size and shape of the heart after myocardial infarction. Human and animal studies have described the mechanisms responsible for the thinning and enlargement that progresses for years beyond the initial infarction. As a result of elevations in preload and afterload, ventricular pressures ...
Pratt N G - - 1993
Ventricular failure is accompanied by a series of neurohormonal responses that result in vasoconstriction. Vasoconstriction develops and is mediated by norepinephrine, angiotensin II, and vasopressin. Vasoconstriction maintains blood pressure but contributes to deterioration in ventricular function. Baroreceptor dysfunction contributes to the syndrome by failing to ameliorate the sympathetic overstimulation. Drug ...
Garg R - - 1993
Several large randomized trials have been completed recently and provided valuable information on the effects of various interventions in heart failure and left ventricular dysfunction. A review of ongoing randomized trials showed that there were 19 major trials addressing the effect of treatments on exercise tolerance, morbidity or mortality. Although ...
Kelly R A - - 1993
Although supported by 2 centuries of anecdotal clinical evidence, the safety and efficacy of the cardiac glycosides for the treatment of congestive heart failure due to systolic ventricular dysfunction had never been rigorously examined by prospective clinical trials until the past decade. A reevaluation of the appropriate role of these ...
Remme W J - - 1993
The initial phase of heart failure is characterized by peripheral mechanisms such as sympathetic stimulation and neuroendocrine activation, which attempt to compensate for the decline in cardiac pump function and tissue underperfusion. However, the resulting vasoconstriction and sodium and water retention lead to a vicious circle wherein the subsequent increase ...
Hood W B WB - - 1993
Treatment with angiotensin-converting enzyme inhibitors has proved to be effective in relieving symptoms of congestive heart failure. With recognition of the high mortality rate that accompanies heart failure, the question has arisen whether angiotensin-converting enzyme inhibitors may also improve survival. Early trials of the vasodilator combination hydralazine plus nitrates (V-HeFT ...
Pitt B - - 1993
The Studies of Left Ventricular Dysfunction (SOLVD) prevention trial evaluated 4,228 patients with a left ventricular ejection fraction < or = 35% who were not receiving drug therapy for heart failure. Patients were randomized to treatment with enalapril or placebo in a dose of 2.5 to 20 mg/day. Patients randomized ...
Jennison S H - - 1993
As understanding of the mechanisms of congestive heart failure (CHF) has improved, it has become apparent that the previously applied stepped-care approach (ie, diuretic, digitalis, then vasodilator) is no longer valid. There is compelling evidence that use of vasodilators increases survival in CHF, and angiotensin-converting enzyme (ACE) inhibitors are the ...
Poole-Wilson P A - - 1993
Advances in the treatment of heart failure with angiotensin-converting enzyme inhibitors have been accompanied by an improved understanding of the pathophysiology of heart failure. The inability of the heart to act as a pump is determined in some patients by alterations to the architecture of the heart and changes in ...
Sonnenblick E H - - 1993
The complex pathology that leads to heart failure has hampered the search for optimal therapy. Even so, ACE inhibitors have become a cornerstone of treatment. After an acute MI, the goal of ACE inhibition is to limit LV remodeling and progression to ischemic cardiomyopathy and congestive failure. In advanced failure, ...
Abraham W T - - 1993
The pathogenesis of renal sodium and water retention in cardiac failure, cirrhosis, and the nephrotic syndrome may be explained by the unifying hypothesis of body fluid volume regulation. According to this hypothesis, underfilling of the arterial vascular compartment initiates a sequence of events, including activation of various neurohormonal vasoconstrictor systems, ...
Chow M S - - 1993
Congestive heart failure (CHF) causes disabling symptoms and increases the likelihood of decreased survival. Diuretics, direct vasodilators, and angiotensin-converting enzyme (ACE) inhibitors can be used to reduce symptoms, prolong life, or both, in these individuals. Diuretics induce sodium and water excretion, leading to decreased cardiac preload and wall tension, and ...
Pfeffer M A - - 1993
Therapy with angiotensin-converting enzyme (ACE) inhibitors was developed approximately 15 years ago as a novel therapeutic approach to hypertension. Although ACE inhibitor therapy was initially reserved for patients with severe hypertension, extensive clinical experience has broadened its use. These agents should now be considered as cornerstone therapy for patients with ...
Johnston C I - - 1993
The success of angiotensin-converting enzyme (ACE) inhibitors in reducing cardiovascular morbidity and mortality rates has led to a reexamination of the role of the renin-angiotensin system in pathophysiology. Ventricular dysfunction leading to congestive cardiac failure is associated with sequential activation of the sympathetic system and increases in plasma atrial natriuretic ...
Sherry K M - - 1993
Milrinone is shown in 10 patients to be a valuable pharmacological bridge to heart transplantation; it can stabilize and improve decompensated chronic heart failure (CHF) in cases where the response to beta-agonists is inadequate. One patient who had suffered an acute myocardial infarction with heart failure resistant to vasodilators, beta-agonists, ...
Cruickshank J M - - 1993
Heart failure is now viewed as a disorder of the circulation, not merely the heart, which becomes manifest only when certain compensatory mechanisms break down. After treatment with diuretics, the two main strategies in treating heart failure involve decreasing the work of the heart by vasodilatation or increasing ventricular contractility ...
Harley A - - 1993
The term heart failure has become a label for more than one clinical entity. For many years heart failure has been used to denote patients with various heart diseases who have begun to suffer from fluid retention, pulmonary venous hypertension, or systemic venous hypertension, either alone or in combination. More ...
Yateman N A - - 1993
Simulation has become practical as an everyday tool given the wide availability of high performance workstations. We argue that simulation can play an important role in determining the number of patients required in a survival study, particularly if the assumption of proportional hazards does not hold, or if the study ...
Pouleur H - - 1993
The use of calcium antagonists in patients with severe dysfunction is controversial because agents like verapamil, diltiazem and nifedipine have been shown to worsen or precipitate congestive heart failure. However, successive improvements in our understanding of the clinical pharmacology of these drugs, of their pharmacokinetics and of their action on ...
Young J B - - 1993
Increased insight has been gained into the pathophysiology of heart failure, which is now recognized as a milieu created by specific diseases that cause myocardial dysfunction resulting in haemodynamic abnormalities. Subsequent compensatory circulatory and hormonal changes cause substantive metabolic derangement, and it is the haemodynamic and metabolic abnormalities that produce ...
Parameshwar J - - 1993
Calcium antagonists have been widely used for the treatment of angina and hypertension. Because of vasodilator and anti-ischaemic properties, calcium antagonists might be expected to bring benefit to patients with heart failure, particularly when the heart failure is due to coronary heart disease. Eight trials of calcium antagonists, fulfilling specific ...
Riegger G A - - 1993
In 1987 the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) was published, which was a milestone for the treatment of patients with heart failure. The study showed a highly significant reduction in mortality in patients with severe heart failure treated with enalapril in comparison to placebo in combination with conventional ...
Yusuf S - - 1993
Several large, carefully randomized studies of pharmaceutical agents in the treatment of patients with congestive heart failure (CHF) and left ventricular dysfunction have demonstrated conclusively that angiotensin-converting enzyme (ACE) inhibitors reduce mortality among patients with CHF, as well as the number of hospitalizations for heart failure, myocardial infarction (MI), and ...
Vargo R - - 1993
Chronic heart failure is a progressive syndrome characterized by diffuse coronary artery disease (CAD) or left ventricular failure not amenable to acute interventions of myocardial revascularization. A spectrum of treatment options is available to such patients. Medical therapies consist largely of pharmacologic alternatives and are used in the early stages ...
Riegger G A - - 1993
BACKGROUND: Chronic blockade of the renin-angiotensin system by angiotensin converting enzyme (ACE) inhibitors in patients with mild to moderate heart failure as a second-line therapy has been shown to exert beneficial effects on exercise tolerance and symptomatology. METHODS AND RESULTS: Studies in experimental heart failure have shown that early inhibition ...
Swedberg K - - 1993
Mortality in congestive heart failure remains high. In analysis of heart failure in the perspective of pathophysiological mechanisms, some approaches to treatment to improve survival become particularly interesting. The concept of unloading myocardial performance by reducing systemic vascular resistance has received general acceptance. This approach was associated with improved survival ...
Remme W J - - 1993
Inodilation, i.e., the combination of positive inotropic and vasodilating therapy, conceptually should be an ideal form of heart failure treatment. However, available orally active inodilator drugs, such as beta-agonists, dopaminergic compounds, and agents with phosphodiesterase (PDE)-inhibiting properties, have not been generally accepted for the treatment of heart failure. In contrast, ...
Gorkin L - - 1993
The improvement of aspects of a patient's quality of life may be as important as prolonging survival in evaluating clinical trials of heart failure. The purpose of this study was to analyze the psychometric properties of the baseline measures from the quality-of-life substudy from the Studies of Left Ventricular Dysfunction ...
Pfeffer M A - - 1993
Ischemic heart disease is the major etiology for the development of congestive heart failure. Patients with acute myocardial infarction have a greatly increased risk for mortality and for manifesting symptomatic heart failure. This risk is not a uniform one but is greatly augmented in patients with a more extensive infarction ...
Mølstad P - - 1993
For more than two centuries digitalis has been used in the treatment of cardiac disease. Despite this long clinical experience with the drug, controversy still exists as to its clinical effect and impact on survival, especially in patients after myocardial infarction. In the last decade a number of studies have ...
Maxwell L P - - 1993
Ten to 15 years ago, the thrust of research in the treatment of congestive heart failure centered around finding new inotropic agents. While initially useful, these agents given chronically actually accelerated left ventricular failure and were associated with excess mortality. Recently, it has been learned that altering the body's response ...
Weber K T - - 1993
Antialdosterone therapy in patients with secondary hyperaldosteronism due to myocardial failure must accomplish the following: (1) reduce or preferably normalize plasma aldosterone levels by blockade of excessive synthesis, (2) antagonize the renal and systemic effects of aldosterone at its receptor sites, and (3) minimize the presence of multiple stimuli to ...
Weber K T - - 1993
Hypertension and atherosclerotic cardiovascular disease represent major global health problems. Practising physicians are challenged daily by patients suffering adverse cardiovascular events, such as myocardial infarction, stroke, heart failure and sudden cardiac death. Major risk factors have been identified of which the most important is left ventricular hypertrophy. In recent years, ...
Binkley P F - - 1993
OBJECTIVES: The objective of this investigation was to evaluate the changes in parasympathetic tone associated with long-term angiotensin-converting enzyme inhibitor therapy in patients with congestive heart failure. BACKGROUND: Angiotensin-converting enzyme inhibitors provide hemodynamic and symptomatic benefit and are associated with improved survival in patients with congestive heart failure. Angiotensin II, ...
Pitt B - - 1993
The natural history of patients with heart failure has changed relatively little until recently. Several large randomized trials have however recently changed our approach to the patient with symptomatic as well as asymptomatic left ventricular dysfunction. Although the effect of digoxin on survival is still uncertain there is still good ...
Groden D L - - 1993
Congestive heart failure is a major clinical and public health problem affecting between 2 and 3 million people in the United States. Whereas myocardial dysfunction assumes a central pathophysiologic role in the development of chronic heart failure, alterations in the peripheral vasculature and neurohormonal systems serve to modulate the heart ...
Steinman R T - - 1993
Some studies have suggested that angiotensin-converting enzyme (ACE) inhibition in patients with heart failure is associated with a decrease in frequency of spontaneous premature ventricular complexes (PVCs). It is not clear whether such a finding represents a primary effect of ACE inhibition or, instead, a secondary result of treatment of ...
Zannad F - - 1993
Secondary aldosteronism has deleterious effects in patients with congestive heart failure (CHF) and can contribute to congestion, ventricular arrhythmias, and sudden death. Mortality is higher in patients with elevated levels of plasma aldosterone. Aldosterone increases as CHF progresses as a result of activation of the renin-angiotensin-aldosterone system (RAAS). This is ...
Veldhuisen, Dirk Jan van
The aim of this thesis was to assess t e role of ibopamine, in the treatment of patients with heart failure. Ibopamine is an orally active dopamine agonist which has beneficial hemodynamic and neurohumoral effects. In the 10 Appendices both clinical and experimental studies are reported that were designed to ...
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